Thornton Lodge Surgery

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that the service delivered effective care and treatment to patients. Overall, we saw that effective care was being provided. However, we saw that care and treatment for patients with asthma had not followed national guidance. The provider had processes in place to work with others to improve patient care and that referrals were actively monitored to check on referral progress. The provider recognised the individual needs of patients and supported them appropriately. We saw that performance in relation to child immunisations and cervical screening participation was below required targets. Though it was noted that the provider had taken steps, which included enhanced community engagement to seek improvements in take up.

This is the first inspection for this service since its registration with CQC. This key question has been rated as Good.

The service was in breach of legal regulations in relation to Regulation 12(1) Health and Social Care Act (Regulated Activities) Regulations 2014 Safe care and treatment This breach related to the failure to deliver appropriate care support for asthma patients.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Feedback from people using the service was mostly positive. For example, 88% of respondents were involved as much as they wanted to be in decisions about their care and treatment during their last GP appointment compared to both local and national averages of 91%. However, only 69% of respondents said that the healthcare professional they saw or spoke to was good at listening to them, compared to a local average of 86% and a national average of 87%. We saw that the provider was highly aware of the cultural needs of patients, and had measures to support this, such as employing staff who spoke multiple languages. Patients that had additional needs had these identified clearly on their patient record, which allowed staff to make adjustments to better meet their needs. In addition, the provider held registers of patients with specific additional needs and used this for care planning and end of life decisions. For example, our remote searches showed that do not attempt cardiopulmonary resuscitation (DNACPR) documentation had been completed in line with guidance. Whilst we saw that patient recall processes were in place, it was noted that the provider at times struggled to achieve attendance from a proportion of their patients due to a failure to come in for reviews and monitoring. The provider told us that part of this failure to attend was because a number of patients left the country for extended periods of time.

The service did not always deliver people’s care and treatment in line with guidance. Systems were in place to share updates and changes to guidance at monthly clinical governance meetings, and other at other learning events. However, whilst our remote clinical searches of patient records showed that most care was provided in line with current guidance, we saw that asthma care needed improvement. Of 261 patients on the asthma register, 16 had been prescribed 2 or more rescue steroids. We looked at 5 of these patients in detail and found that all 5 patients had concerns regarding their care and treatment. For example, 4 out of 5 patients had not been followed up by the provider within 48 hours of an asthma exacerbation, 2 out of 5 patients had not been issued with a steroid card, 3 out of 5 patients were overdue an asthma review, and 2 out of 5 patients had not been seen after prescribing a medication for an acute asthma episode. We discussed these cases with the provider who told us that some of these patients had failed to attend reviews after recall requests, or had failed to make follow up appointments after being requested to do so. They told us that they would review their asthma recall and follow up appointment booking processes. We saw that medicines reviews had been satisfactorily undertaken and carried the appropriate level of detail.

The service worked well across teams and services to support people. Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The provider worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. We saw that the provider had in place processes to ensure the monitoring of referrals to other services such as 2-week wait cancer referrals. The provider met regularly with multidisciplinary colleagues including community and palliative care nurses, health visitors and safeguarding teams to discuss vulnerable patients or those with complex needs.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support. We saw that the provider was committed to supporting, encouraging and enabling their patients to live healthier lives. We heard how they had recognised the challenges they faced regarding local health issues such as diabetes, smoking and a lack of participation in public health programmes, and had put in place measures to tackle these. For example, they had worked with a local community group to organise and publicise cervical screening, and stop smoking support. In addition, they had developed awareness resources to support diabetic patients to better control their condition during Ramadan.

The service did not always routinely monitor people’s health and vaccinate children in line with national targets. They had though put in measures to improve performance in these areas and had in place other activities to improve population health outcomes. The provider had failed to meet targets for cervical screening and child immunisations. For example, figures for 2022/23 showed that 4 out of 5 child immunisation targets were below 80% uptake, and 1 was below the 90% minimum uptake target. Cervical screening for 2022/23 showed an achievement of 52% participation against a national target of 80%. The provider recognised both these issues as concerns. They told us that they faced significant cultural challenges from their patients, which showed itself as a reticence to take part in these programmes. Despite this the provider had taken action to improve performance. For child immunisations staff regularly and repeatedly invited parents to bring in their children for vaccinations. Information regarding non-attendance was also shared with health visitors. For cervical screening, the provider had worked closely with a local community group to promote attendance at a hosted event in the surgery. The event was solely staffed by women, and sought to raise awareness and breakdown barriers to participation. During the event, 3 women had a screening undertaken, and feedback was very positive. At the time of our assessment the provider shared with us unverified data which showed a current screening rate of 73%. In addition, over the previous 12 months only 2 health checks were undertaken for patients with a learning disability out of 20 on their register. To improve take up of these checks the provider had implemented measures promoting these checks, offered patients extended hours appointments, and planned jointly working with the local learning disability service.

The service told people about their rights around consent, and respected these when delivering person-centred care and treatment. Staff we spoke with were able to give examples of how consent was considered, sought and recorded (where appropriate). They had a good understanding of considerations which needed to be made for children and young people, those with limitations to mental capacity, the vulnerable or elderly, or those whose first language was not English. Many staff had the necessary language skills to discuss consent issues with patients in their preferred language. We saw that relevant staff had received training regarding the mental capacity of patients, which enabled them to effectively assess the patient’s ability to give consent. The provider used implied consent for most procedures, however they also required specific written consent when undertaking certain more complex, personal, or invasive treatments. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.